Benefits of delayed revascularization following ligation of anterior descending artery after a stab wound

Abstract

Penetrating cardiac trauma often results in death. However, in rare cases when patients survive, there is almost always a need for damage control by artery ligation. Following that, revascularization is recommended as soon as possible. The extent to which revascularization is effective has not yet been studied and agreed upon. A 24-year-old man with a penetrating stab wound to the heart and left anterior descending (LAD) artery received primary life-saving treatment with artery ligation and was then referred for revascularization. Nonetheless, the patient did not consent to coronary artery bypass grafting (CABG) and was discharged against medical advice with ejection fraction (EF) of 20%. He returned three months later due to chest pain and heart failure, then underwent revascularization which increased the patient’s EF to 45% and significantly improved the symptoms. Although CABG revascularization is recommended as soon as possible after main coronary arteries are ligated, our patient showed that such patients benefit from delayed revascularization surgery and that they should not be deprived of its benefits only because of the long time passed.

Keywords

• cardiac stab wound
• heart injury
• left anterior descending
• coronary artery
• delayed revascularization